Tài liệu Information in use and outsourcing aspects of digital doc

7.3 IDENTIFICATION OF TASKS AT AKC 90 7.4 IDENTIFYING INFORMATION TYPES, FLOWS AND DIALOGUES AT AKC 90 7.5 ENSURING INFORMATION QUALITY AT AKC 97 8.2 MAIN TYPES OF VALIDATION FOR SERVICE

In memory of my beloved mother Inger,

always near to me

A BSTRACT

This thesis is founded on the global growth of the service sector and its significance for society as a whole and for the individual human being In the last decade, technology has changed the way services are created, developed and delivered in remarkable ways The focus of the thesis is technology in interplay with humans and organisations and the socio-economic-technical systems in which digital services play a central role Challenges addressed by the thesis include requirement analysis, trustworthy systems, in- and outsourcing aspects, the proper understanding of information and its use in real world applications With this in mind, the thesis presents a configurable methodology with the purpose to quality assure service oriented workflows found in socio-economic-technical systems Important building blocks for this are information types and service supported workflows

Our case study is of a call centre-based business called AKC (Apotekets kundcentrum) AKC constitutes a part of the Cooperation of Swedish Pharmacies (Apoteket AB) One of their main services offered to Swedish citizens is the handling of incoming questions concerning pharmaceutical issues We analysed the interactive voice response system at AKC as a starting point for our investigations and we suggest a more flexible solution

We regard a socio-economic-technical system as an information ecology, which puts the focus on human activities supported by technology Within these information ecologies, we have found that a Service Oriented Architecture (SOA) can provide the flexible support needed in

an environment with a focal point on services Input from information ecologies and SOA also enables a structured way of managing in- and outsourcing issues We have also found that if we apply SOA together with our way of modelling a Service Level Agreement (SLA), we can coordinate high-level requirements and support-system requirements

A central insight in this work is the importance of regarding a economic-technical system as an information ecology in combination with in- and outsourcing issues This view will prevent a company from being drained of its core competences and core services in an outsourcing

socio-separate services and apply economic aspects to them This enables us to analyse which services that are profitable while at the same time meet important requirements in information quality

As a result, we propose a set of guidelines which represent our approach towards developing quality assured systems We also present two main types of validation for service oriented workflows: validation of requirement engineering and validation of business processes

To my loving family and to my wonderful friends: thank you Thank you for always being there for me and believing in me Finally, to my husband Martin: your support is beyond words I would never have managed to deal with the events of the last few years without you You make me the happiest woman on earth

Carpe diem

Louise

T ABLE OF CONTENTS

CHAPTER 1 INTRODUCTION 1

CHAPTER 4 SERVICES AND SERVICE DEVELOPMENT 39

4.1 INTRODUCTION 39 4.2 THE CHANGE OF THE SERVICE CONCEPT 40 4.3 SERVICE DEVELOPMENT IN APOTEKET’S CONTEXT 41 4.4 QUALITY ASPECTS OF THE SERVICE CONTEXT 45 4.5 CONNECTION TO THE REMAINING PART OF THE THESIS 47 4.6 SUMMARY OF CHAPTER 49

CHAPTER 5 THEORETICAL ASPECTS OF INFORMATION

5.1 INTRODUCTION 51 5.2 REPRESENTATION, INFORMATION AND KNOWLEDGE 52 5.3 SITUATIONS, TYPES AND INFORMATION EXCHANGES 54 5.3.1 SITUATIONS AND TYPES 54 5.3.2 EXCHANGING INFORMATION 57 5.4 SEMANTICS 58 5.5 INFORMATION FLOWS, SITUATIONS AND TYPES AT AKC 59 5.6 INFORMATION AND INFORMATION SECURITY 61 5.7 INFORMATION QUALITY AND INFORMATION ASSURANCE AT AKC 64 5.8 INFORMATION ECOLOGIES 65 5.8.1 WHAT CHARACTERIZES AN INFORMATION ECOLOGY? 66 5.9 AKC VIEWED AS AN INFORMATION ECOLOGY 69 5.10 SUMMARY OF CHAPTER 72

6.1 INTRODUCTION 73 6.2 MODELLING PROCESS 75 6.2.1 CONTEXT LEVEL 76 6.2.2 CONCEPT LEVEL 77 6.2.3 ARTEFACT LEVEL 80 6.3 SUMMARY OF CHAPTER 82

7.1 CHALLENGES REVISITED 83 7.2 IDENTIFICATION OF WORKFLOWS AT AKC 85

7.3 IDENTIFICATION OF TASKS AT AKC 90

7.4 IDENTIFYING INFORMATION TYPES, FLOWS AND DIALOGUES AT AKC 90

7.5 ENSURING INFORMATION QUALITY AT AKC 97

8.2 MAIN TYPES OF VALIDATION FOR SERVICE-ORIENTED WORKFLOWS 102

8.2.1 VALIDATION OF REQUIREMENT ENGINEERING 103

8.2.2 VALIDATION OF BUSINESS PROCESSES 106

8.3 OTHER VALIDATION ASPECTS 108

8.4 CONCLUSIONS 109

8.5 SUMMARY OF CHAPTER 111

9.1 THOUGHTS ON FUTURE WORK 113

REFERENCES 121

F IGURE 1.1 G ENERIC ARCHITECTURE FOR SOCIO - ECONOMIC - TECHNICAL SYSTEMS 3

F IGURE 3.2 T REE - STRUCTURE FOR THE INTERACTIVE VOICE RESPONSE - BASED

F IGURE 3.3 D IFFERENT ASPECTS AND ISSUES CONCERNING SOCIO - ECONOMIC -

F IGURE 3.4 P ERSPECTIVES ON A SOCIO - ECONOMIC - TECHNICAL SYSTEM 36

F IGURE 4.2 W HERE THE DIFFERENT METHODOLOGIES AND THEORIES ARE USED IN

F IGURE 5.3 A MESSAGE EXCHANGE WITHOUT COMMON GROUND 63

F IGURE 6.2 M ODIFIED TASK MODEL ( TO THE RIGHT ) IN RELATION TO THE SOCIO

-ECONOMIC - TECHNICAL SYSTEM ( TO THE LEFT ) 76

F IGURE 6.3 O VERVIEW OF THE COORDINATION MODEL WITH SLA 78

F IGURE 6.4 O VERVIEW OF THE COMMUNICATION MODEL [5] 79

F IGURE 6.5 G ENERAL LAYOUT OF A DIALOGUE DIAGRAM [5] 80

F IGURE 6.6 SOA AS A SUPPORT FOR CUSTOMER ORIENTED WORKFLOWS 81

F IGURE 7.1 C HALLENGES FOUND IN SOCIO - ECONOMIC - TECHNICAL SYSTEMS 85

F IGURE 7.2 D IVISION OF AKC’ S BUSINESS PROCESSES INTO SMALLER ELEMENTS 86

F IGURE 7.7 C RITICAL HAND - OVER SITUATIONS IN THE OVERALL WORKFLOW 93

F IGURE 7.8 A DIALOGUE SITUATION EXTRACTED FROM THE OVERALL WORKFLOW 94

F IGURE 8.1 A RCHITECTURE FOR VALIDATION EXPERIMENTS 102

1.1 Setting the scene

In the opening sentences of the Seventh Framework Programme for 2007-2013 by the European Commission, one can read that Europe faces

an urgent need to reshape its economy and society to be able to meet the challenges of the 21st Century This fact is based on the globalisation of markets and the ever faster pace of technological change Furthermore,

we also have to modernise public services and tackle emerging challenges within different areas, e.g the health sector [1] Globalisation, the increasing automation, the growth of the Internet and the dynamic componentisation of business are driving the reconfiguration of service value networks at a scale and pace never seen before in history The opportunity for innovation, research, development, realisation of business and societal value and delivery of new information and business services has never been greater [2]

This not only holds for the term “service” that today is most commonly associated with Web services or Service-Oriented Architectures, (SOA); there has been a remarkable growth in the service sector as a whole since

it has dominated the economic activity for the last 50 years [2] Our society today is increasingly built upon digital services and soon we will fully enter a digital service society where these services will play a central

role in our daily lives When this happens, they will be a natural and important part of the socio-economic-technical context in which people and machines co-operate

This development of the service sector and the challenges that Europe faces is behind our interest in digital services, the main topic of this thesis

We argue that one of the overall purposes of digital services is to mediate information, which makes information a fundamental part in this context Hence the title “Information in use” With this title as a starting point we then chose to focus on two different aspects which we think are of great importance, namely aspects of information quality in workflows where digital services are a vital part and also in- and outsourcing aspects of digital services In this thesis we have used a customer care centre (Apotekets Kundcentrum which from now on will be referred to as AKC) which is part of the Corporation of Swedish Pharmacies (Apoteket AB which from now on will be referred to as Apoteket) as a case study Apoteket is the sole retailer of pharmaceutical products in Sweden Today, some of the services at AKC are digital and the ratio of these are increasing within the organisation However, the results presented are also valid for other types of businesses that use digital services in their daily work The results of the research are based upon the same core, but are

presented in two different theses written by Patrik Brandt (Information in

use: aspects of information quality in workflows) [3] and Louise Östlund

(Information in use: in- and outsourcing aspects of digital services) respectively The

results from these theses are closely related and can be seen as one unit, but can also be read individually or as a complement to each other

1.2 The purpose of the thesis

The overall purpose of this thesis is to find ways to assure the quality of the information flow between a customer and a human agent at, for example, AKC Assuring the information flow in a situation where the customer or AKC’s personnel interact with digital services is also of interest Beside the overall purpose, Louise Östlund’s thesis deals with in- and outsourcing aspects of digital services and Patrik Brandt’s thesis exemplifies how information quality can be achieved in workflows where digital services play a central part

1.3 Overview of the thesis

As mentioned before, services are central to this thesis These services in turn support work- and information flows and it is of great importance that these are quality assured, especially in a context like the one at AKC

since they deal with and mediate pharmaceutical information In order to manage requirement elicitation and requirement engineering that support identification of workflows and services, we have used a configuration of different tools, methodologies and theories Figure 1.1 illustrates how these are involved in our work, and it also shows how the methodologies and theories have been used and how they are connected More thorough descriptions of the components that are shown in the figure are given in

the forthcoming Chapter 4 Services and service development, Chapter 5

Theoretical aspects of information and communication, Chapter 6 Methodological issues and Chapter 8 Models of validation and conclusions respectively

Figure 1.1 Generic architecture for socio-economic-technical systems

Figure 1.1 illustrates our socio-economic-technical system In the upper part we find the workplace consisting of people (e.g customers, employees) together with an idealised, normative workflow in an organisation The workflow is realised when a number of tasks are carried out; some of these by humans and others by machines We have drawn a line around the people and the workflow that shows that this is a part of the organisational context in which they work, i.e the workplace This workplace is also our object of study, and it is supported by and closely related to an underlying technical structure In our effort to understand the workplace, we are helped by different theories and methodologies We

requirements

High-level requirements Support

Ethnographical aspects

Infosense aspects

Service Oriented Architecture

Information Ecologies

Service Level Agreement

Service bundle

Other aspects Workplace

Workflows

Customers Customers

have chosen to focus on the Infosense theory [4], the CommonKADS methodology [5] and also ethnographical aspects to a certain extent We are aware of the fact that other relevant aspects exist, e.g economic, human behaviour, human computer interaction and so on, but we have chosen the ones that are relevant to the purpose of the thesis Another reason not to add more aspects than the ones we have outlined is that we need to minimize the aspects considering the complexity in socio-economic-technical systems However, we will to return to economic

aspects related to in- and outsourcing of services in Chapter 8 Models of

validation and conclusions

To be able to analyse a complex socio-economic-technical system, we need to consider the sociological and the technical aspects of this system because they are closely related and interwoven For instance, the requirements for support that people have in order to perform different tasks in the workflow, must match the possibilities the underlying technical infrastructure can offer Accordingly, there are a number of requirements that must be fulfilled to achieve a well-functioning workflow We have divided these into high-level and support-system requirements These concepts are well-known within the area of software engineering, but are in those situations influenced by technical aspects and are often restricted to requirements that are directly measurable In socio-economic-technical systems however, we see that very crucial trust-related requirements come from the part of the figure above the dotted line, a section we refer to as information ecologies since these requirements act

as support in the process of performing tasks correctly The part of the figure below the dotted line must then complete certain technical functions to fulfil the support-system requirements, and some technical functions are furthermore a part of the support-system requirements

In our case, the technical part of the system is based upon an SOA The high-level and support- system requirements meet in a Service Level Agreement, (SLA), which acts as an interface between the sociological and the technical part of the system The SLA is derived from CommonKADS meta models and it collects different kinds of services to something we call a service bundle, that supports and coordinates the workflow

In this thesis, I have chosen to focus particularly on in- and outsourcing aspects of digital services in these socio-economic-technical systems These aspects are often discussed in connection with the concept of

support-system services and I believe that they are often treated too lightly Many organisations bring this into play citing how others have saved lots of money and increased their efficiency at the same time This

is true for some organisations but not for all, there is no one-size-fits-all when it comes to in- and outsourcing In my view, all of this has to do with the type of business and the information the business is built upon Locating and defining an organisation’s information ecology, in which core business and high-level requirements exist, will be of utmost importance when discussing whether to outsource certain services or not This also holds for the decision to insource; which services can be incorporated into existing information ecologies? How can these ecologies

be encouraged to evolve without disturbing the ecological invariants? Thus, the greatest challenge is to achieve resilient information ecologies so that a business can be profitable and continue to deliver digital services without letting go of its core business and appurtenant information

Solutions to this are briefly described in Section 1.4 Results

1.4 Results

A result of this thesis is the compilation of a number of key methodologies that can be configured to analyse workflows and socio-economic-technical systems Another result, arising as a consequence of compiling key methodologies, is the development of guidelines which serve to first identify fundamental information types within workflows and then identifying necessary service types to support these workflows The service types can then be bundled together to specific service bundles, which then can be analysed and executed with respect to performance, to other support-system requirements and also to high-level requirements In this way, we have met the challenge to create a reusable way of analysing workflows and socio-economic-technical systems

1.5 Own contributions

While working on this thesis, we wrote papers and gave conference contributions to address different issues related to the AKC context A Licentiate thesis has also been written around the same theme Our contributions are listed in Table 1.1

Table 1.1 Own contributions

Nr Title Authors Way of presentation

ISSN 1651-0275 ISBN 91-974341-2-4

2 Risk Analysis in Contact

Centres Brandt, P., Révay, P &

Wennberg, L

(2003)

The 4th International Conference of PhD Students, Hungary

Révay, P (2004)

MicroCAD 2004, International Scientific Conference, Hungary

4 System Thinking in Risk

Analysis Brandt, P., Révay, P &

Wennberg, L

(2004)

The Forty-Eight Meeting

of the International Society for the System Science, USA

6 Information Security – an

application of a systems

approach

Wennberg, L., Brandt, P &

Révay, P (2006)

Kybernetes: The International Journal of Systems & Cybernetics, Vol.35, Issue 6

Support in Life Critical

Situations

Gustavsson, R., Brandt, P., Lundberg, J &

Östlund, L

(2006)

Submitted to: The Journal

of the Brazilian Computer Society – Special Issue on Software Engineering for Multi-Agent Systems

8 The Call Centre, a

Complex Critical

Information System – but

for what kind of

information?

Brandt, P., Gustavsson, R.,

& Östlund, L

(2006)

Submitted to: The Journal

Of Strategic Information Systems

One common denominator for the first six contributions is that they are (in one way or another) built upon a system-theoretical approach, with emphasis on the General System Theory, GST [6] However, this theory is

no longer suitable for the approach presented in this thesis, since we are now focusing on and analysing socio-economic-technical systems where

we need to model information types, workflows, support-system requirements, and high-level requirements With this approach, we are not modelling in- and output or feedback loops etc, for which GST might be helpful

In Table 1.2 we list the contributions from Table 1.1 in relation to a number of subject fields, which we consider to be the main field for the dissertation work Depending on their relevance to the dissertation work they have been assigned plus signs (+) where three plus signs indicate a strong relevance and no plus sign signifies no relevance

Table 1.2 Relevance for the dissertation work

We have also established contacts and meetings with other organisations, e.g Kalmar County Council Their responsibilities include the public medical service and they thus have a connection to Apoteket’s main business which is pharmaceutical products These contacts have been of great value to us in the work with testing ideas and results During our work, we have found that digital services will be of great importance in the future; especially for businesses and organisations like the one mentioned above Moreover, our research about and approach to digital services and information has also created interest elsewhere An example

of this is our own university where they see a possibility of introducing this approach into undergraduate and masters studies combined with

1 Contribution 5 is our Licentiate thesis, which includes contributions 1, 2, 3, 4 and 6

continuous research together with our research group, Societies of Computation, SoC, at Blekinge Institute of Technology [7]

1.6 Assessment of the Licentiate Thesis

The Licentiate thesis [8] has resulted in a number of debriefings, workshops and meetings with involved persons from Apoteket These occasions have in turn resulted in discussions between representatives from Apoteket and us about important questions at hand for AKC and its future business Initially, the questions we discussed concerned different risks identified in the Licentiate thesis but these discussions have now moved on to other issues They now focus not only on the new services that have gradually been added to AKC’s business but also on the future role of AKC and its importance as a part of Apoteket Lately, the discussions with Apoteket has been characterised by the ongoing debate about the deregulation of Apoteket’s monopoly These discussions are at present being carried on by the Swedish Government The final decision had not been taken at the time of writing, but regardless of the outcome, AKC will play an important role for Apoteket as a whole

During the writing of the thesis in general and the doctoral thesis in particular, a continuous dialogue has been kept with Apoteket in the form

of idea seminars, video conferences, interviews etc in which a form of validation did take place At these occasions, new ideas were tested as they came up We see Apoteket’s and AKC’s role in this project as an interesting and engaged study object, from which we have been able to collect real examples that have an important connection to the public welfare in Sweden

1.7 Thesis structure

The remaining part of this doctoral thesis is structured as follows:

In Chapter 2 Background, we present the background to this thesis and in Chapter 3 Case Study we describe the case study object AKC, together with

issues related to socio-economic-technical systems These issues are furthermore based on analysis of the existing interactive voice response

system and error reports In Chapter 4 Services and service development, we

present an overview of services and their development with special focus

on digital services In Chapter 5 Theoretical aspects of information and

communication, we discuss theoretical aspects of information and

communication by using Devlin’s theory of information (Infosense), and

in Chapter 6 Methodological issues we present methodological issues based

on the CommonKADS methodology which we have also revised to some

extent In Chapter 7 Our approach, we give further details about our

approach to the case study and how we have put theories and

methodologies into practice In Chapter 8 Models of validation and conclusions

we discuss these models of validation as a way to bring forward quality

assured socio-economic-technical systems In Chapter 9 Future work we

make our conclusions and discuss future work and other approaches such

as related work, which is followed by a Glossary that defines the central

terms for this thesis These central terms are marked with an asterisk (*) when they appear for the first time in the forthcoming chapters The

thesis concludes with a list of References used in this thesis and an Appendix

1.8 Guidelines to the reader

In contrast to Section 1.7 above, where we give a very short description of each chapter in this thesis, we want to use this section as an opportunity

to highlight some chapters that are central to this thesis To be specific,

these are Chapter 3 Case study, Chapter 7 Our approach and Chapter 8

Models of validation and conclusions

In Chapter 3 Case study, the reader finds a background description of AKC

and a discussion about different effects as a result of AKC’s establishment This continues with the virtual organisation for AKC, which constitutes an identification of agents that are directly or indirectly involved in AKC’s business We also present a more detailed description

of these agents and their roles respectively An important component in AKC’s business is the National Pharmacy Register, in which data of the customers’ total use of pharmaceutical products are stored Obviously, this is considered to be a very sensitive register and is therefore guarded

by a number of rules and regulations which are presented in the section about legal framework Another component presented in this chapter is AKC’s interactive voice response, which is the customer’s first contact with AKC’s service supply This interactive voice response and its structure turned out to be important for our work, and these elements are therefore discussed further in the chapter We also put forward real examples of mistakes made within Apoteket’s context These examples are extracted from error reports from The National Board of Health and Welfare in Sweden and can be seen as examples of insufficient

information quality Chapter 3 also includes a section called Towards a

configurable methodology in which we outline a number of challenges related

to different aspects of socio-economic-technical systems like AKC, namely socio-related, technical and economic challenges

In Chapter 7 Our approach, methodologies and theories are put into

practice and are thus applied to our case study object AKC In this chapter, we describe our approach to business processes and how we divide them into smaller parts, namely workflows, tasks and dialogues Next, the identification process of workflows at AKC is described and the actual workflow at AKC is presented as a result of performed ethnographical studies Together with this, the importance of the interactive voice response is once again discussed, since it activates AKC’s workflows and will also have an impact on the overall work procedure In accordance with our division of business processes into smaller parts, the next step is to break down the identified workflow into tasks, which are described and also connected to the CommonKADS methodology A great part of the chapter is devoted to the identification of information types, information flows and dialogues at AKC In connection to this, the CommonKADS methodology is used once again but this time in combination with Devlin’s Infosense theory

According to us, the tasks are performed by means of certain dialogues and we have found that critical hand-over situations take place when information is to be transmitted between these dialogues Considering this fact, we pursue a discussion about what takes place in a specific dialogue situation, the complexity that occurs when serial dialogues appear and so

on We also discuss the complexity of problems that arise as a result of possible misinterpretations and we state how important it is to ensure information quality in a consultative business like AKC The chapter concludes with previous challenges revisited, where we suggest six overall information types as a proposal of how to categorise the existing information types in AKC’s digital information system These six information types can also be used to great advantage to reorganise AKC’s supply of services and also act as a foundation for a new way of structuring in the interactive voice response as well We also propose a set

of guidelines towards developing systems with assured qualities, developed by our research group SoC

Finally, in Chapter 8 Models of validation and conclusions, we discuss models of

validation in relation to the earlier presented socio-related, technical and economic challenges We also present three main types of validation of service-oriented workflows, with input from the set of guidelines

presented in Chapter 7 Our approach In the chapter we mainly focus on

validation of requirement engineering and validation of business processes but we also discuss other validation aspects, such as automation

C HAPTER 2 B ACKGROUND

In this chapter we present findings from our Licentiate thesis, which forms a background

to this thesis As a result of the Licentiate thesis, we present three important main tasks that constitute a foundation for AKC’s business processes and service supply

2.1 Input and findings from the Licentiate thesis

We have in our previous published Licentiate thesis [8] emphasised the importance of using a holistic perspective when it comes to security issues and risk analysis processes together with larger organizational changes and integration matters in particular In relationship to the latter, we especially refer to integrations of different communication channels The holistic approach that was used in the Licentiate thesis was influenced by the way

of thinking that is emphasised within General Systems Theory, (GST) [6] This was applied to our reasoning on security where we accentuate that it

is not one single component that constitutes a secure organisation; instead

a number of co-operating factors put in a larger context together contribute to increased security In the Licentiate thesis, important sustainable socio-economic-technical aspects, in the shape of interactions between people, organisation and technology, are also put forward These socio-economic-technical aspects are important in order to be able to offer different business related services* with support from suitable infrastructures The application area for the Licentiate thesis was AKC, which at that point had just been established Our focus was then turned

to an overall reasoning about security with a starting point in risk analyses

of this kind on “new” business within Apoteket

In this thesis the application area is the same, i.e AKC However, we are

no longer using GST or other system aspects that have a more “pure” approach found within e.g mechanical, sociological or biological systems Instead, our way of looking at systems* in this dissertation is characterized

by a socio-economic-technical perspective, i.e we are interested in the operation between humans and technology In these open socio-economic-technical systems, the input or output that people usually refer

co-to when discussing systems, does not exist; what drives these systems are the internal processes like workflows* and information flows The same

line of thought is also found in Nardi and O´Day’s Information Ecologies

where an information ecology is viewed as a system of people, methodologies, technologies and values that co-exists together in the same environment [9]

After a couple of years in operation, we would argue that AKC has established its organisation and located its role within Apoteket The fundamental thought is that there should be no difference for the customer if he or she chooses to turn to AKC or to a traditional local pharmacy The service supply and the total experience should be the same During the time we studied AKC, we identified three main tasks* where AKC:

• Mediates products that are available both with and without prescription and information belonging to them

• Functions as a portal for healthcare

• Promotes better use of pharmaceutical products among Swedish citizens

Mediating pharmaceutical products has been a core business for Apoteket from the very beginning and lately the information belonging to these products has also been increasingly important This importance is not unrelated to the fact that great returns from the information on how to use pharmaceutical products have been noticed, both from a national-economic perspective and from a health perspective Together with this, invested resources have enabled the offer of preventive measures into something that can be seen as a portal for healthcare Here we refer to the possibility of the customer to search for advice and help, concerning health and self-care at Apoteket’s homepage (www.apoteket.se) Through

these main tasks, Apoteket offers a number of services, a concept which we

consider of vital importance when we study AKC and its business

Therefore, we want to state that the main tasks for AKC amounts to delivering different kinds of services, some digital, to their customers Considering the fact that Apoteket is active within the area of pharmaceuticals and healthcare, it is of utmost importance that the delivered services are of the highest quality This can, according to us, be maintained through the assurance of high information quality The focus

in this thesis has thus been the assurance of central workflows in critical business processes*, and we find examples of these kinds of flows and processes within AKC

2.2 Summary of chapter

In this chapter, the following is discussed:

• In the Licentiate thesis, General Systems Theory was applied, but this theory is now left behind

• In the Licentiate thesis, important sustainable technical aspects in the shape of interactions between people, organisation and technology were put forward

socio-economic-• Three main tasks at AKC have been identified, arguing that it:

o Mediates products that are available both with and without prescription and information belonging to them

o Functions as a portal for healthcare

o Promotes a better use of pharmaceutical products among Swedish citizens

• Through the three main tasks a number of services are offered

C HAPTER 3 C ASE STUDY

In this chapter we discuss what the establishment of AKC has resulted in, both for Apoteket as an organisation and for their customers We also highlight legal frameworks that have had an effect on AKC’s business, principally in relation to the National pharmacy register We identify the virtual organisation for AKC together with involved agents and we outline the present structure of the interactive voice response

We also put forward examples of real mistakes made within Apoteket’s context, and

we use these examples to suggest alternative structures that may result in better workflows The chapter concludes with a discussion of a configurable methodology and a presentation of three central challenges: socio-related, technological and economic

3.1 Background

The establishment of AKC has brought with it a number of positive effects, both for the overall organisation and for the customers For the customers, AKC provides an increased accessibility to some of the services offered by Apoteket as well as independence of time and space Only 10 % of the incoming events* at AKC, have been redirected to the local pharmacies [10] and AKC had up until November 2005 handled

6 280 000 events [11] This has in turn decreased the workload at the local pharmacies, which has resulted in more time left that could be spent on the customers for e.g counselling in self-care issues [10] Furthermore, the traditional paper prescriptions are now to a larger extent being replaced by

a new type of information management in the form of electronic prescriptions Their number is constantly increasing and during the summer of 2005, over 1 million electronic prescriptions were served per month [12] The underlying idea of these electronic prescriptions, according to Apoteket’s annual report for 2002, is partly to free up resources in order to focus on the right things at the local pharmacies, to

avoid mistakes and to increase the service level towards the customers [13] According to Apoteket, the fact that an electronic prescription is written directly into the computer and then transmitted to Apoteket’s computer systems, minimises the risks for typing errors and misinterpretations [14]

However, this steering of customer event-flows towards what we would like to call a portal of services shows an important responsibility and commitment from Apoteket’s point of view, e.g when it comes to maintaining the customer’s confidence in their trade mark Deliveries and services are supposed to work in the same secure and controlled way as before, despite the fact that customers and personnel at AKC no longer are at the same geographical spot This can give rise to a number of difficulties like authentication, accountability, traceability, semantic problems in dialogue* with the customer, lack of body language, the possibility of demonstrating various pharmaceutical products like inhalers and so on Furthermore, the constant stream of incoming calls and the amount of information generated for AKC, should give rise to an increased investment in quality assurance and control Especially since AKC, like many other call centres, have a vision of having the shortest queue time possible and that each customer event should be handled as quickly as possible This vision has been translated into a number of goals that state that a customer event should be limited to a certain time period The time each customer event takes is thus monitored by the system The given question in this situation is: how far can we automate things without jeopardising the customer’s security and well being? Thus, one should consider whether there should really be a time limit at all for more advanced customer events in an organisation of this kind

To establish contact with AKC, a customer uses one of the communication channels that are currently connected to AKC, i.e telephone, e-mail, fax or Apoteket’s homepage If the customer chooses

to establish contact with AKC by telephone, he or she will first be met by

an interactive voice response which is a part of the digital information system* at AKC The interactive voice response is constructed and structured in such a way that the customer must make a number of choices depending on the nature of the event (a mapping of this structure

is found in Appendix A) After that, the digital information system forwards the event to a human agent* with the right competence to handle the event This action is based upon the choice made by the customer A human agent at AKC can be a pharmacist or a non-

pharmacist, where the pharmacist is the only person allowed to handle and give answers to events concerning prescription pharmaceuticals; the remaining events can be handled by a non-pharmacist Some of the events can be dealt with automatically and do not require any direct involvement

of a human agent, e.g questions about opening hours With regard to the incoming event, the digital information system tools and services are used when searching for answers to the customer’s question A human agent can also ask another human agent for further information to be able to help the customer, or can hand over the event completely to the other agent The final stage in this workflow is when the answer is communicated to the customer

3.2 The virtual organisation for AKC

To assure the quality of information- and workflows, we must define what

we would like to call the virtual organisation for AKC (cf Figure 3.1) This is

necessary in order to identify those agents* that are needed to perform the different services offered by AKC and also to identify other authorities and agencies which have a governing and controlling function on AKC

By doing this, we can more easily establish which parties are directly or indirectly involved in the workflow and which authority rules the organisation must conform to Figure 3.1 can be seen as a refined and extended figure of the workplace* depicted in Figure 1.1 It describes the virtual organisation, where the area within the line includes those agents that are directly involved in the earlier described overall workflow at AKC Outside this line, various governing and controlling authorities and agencies that have an indirect effect on the same workflow can be found Here, the owner structure around AKC can also be found The acronyms

in Figure 3.1 are explained in the next sections, Section 3.2.1 Agents and Section 3.2.2 Governing and controlling authorities and agencies

Figure 3.1 The virtual organisation of AKC

Digital Information System, DIS

The underlying technical architecture, which supports AKC’s business

3.2.2 Governing and controlling authorities and agencies

We have found that the following governing and controlling authorities and agencies are indirectly connected to AKC:

The Swedish Data Inspection Board, SDIB

The Swedish Data Inspection Board is a public authority tasked with protecting the individual's privacy in the information society without unnecessarily preventing or complicating the use of new technology [17]

The National Board of Health and Welfare, NBHW

The National Board of Health and Welfare is the Swedish national expert and supervisory authority for social services, public health, infectious diseases prevention and the health services The Board seeks to ensure that efforts in these areas are of good quality and are distributed according

to need The work must also be cost effective within allocated resources and in accordance with the legislation [18]

The Pharmaceutical Benefits Board, PBB

The Pharmaceutical Benefits Board (PBB) is responsible for determining whether a drug or other items covered by the pharmaceutical benefits scheme is to be subsidised This means that the PBB replaces the National Social Insurance Board in the task of pricing medicines The PBB is also

in charge of reviewing all current medicinal products and determining whether the product will continue to be listed on the pharmaceutical

benefits scheme [19]

The Medical Products Agency, MPA

The Medical Products Agency (MPA) is the Swedish national authority responsible for regulation and supervision of the development, manufacturing and sale of drugs and other medicinal products Their task

is to ensure that both the individual patient and healthcare professionals have access to safe and effective medicinal products and that these are used in a rational and cost-effective manner [20]

The Medical Responsibility Board, MRB

The Medical Responsibility Board (MRB) is a national authority which assesses medical negligence If healthcare staff is at fault, for example pharmacists, the Board can take disciplinary action against them [21]

3.2.3 Owner structure

The owner structure connected to AKC is as follows:

The Corporation of Swedish Pharmacies (Apoteket AB)

Here, we refer to the main organisation of which AKC constitutes as a part

The Swedish Government

The Swedish Government owns Apoteket AB

3.3 Legal framework

Apoteket’s service supply is constantly increasing and one of the new services is the National pharmacy register which can be used by the patient/customer, prescribers and pharmacists The register contains data* of a customer’s total use of pharmaceutical products This was made possible when a new law (2005:258) concerning a National pharmacy register [22] came into force on the 1st of July 2005 Broadly, this implies that a new personal register is established and it also implies the following (freely translated) [23]:

“The register will contain data of prescribed pharmaceuticals that a particular patient collects from a pharmacy The purpose of the register, which shall be kept by Apoteket

AB, is to collect all information about the patient’s pharmaceuticals, regardless of who prescribed the pharmaceutical or at which health care unit this was done The data in the registry is supposed to be used by patients, prescribers and pharmacists at pharmacies The registration of the data itself shall be made without the consent of the patient However, access to the data in the register is dependent upon the explicit consent of the patient The law also contains provisions about the content of the register, direct access, search concepts, information, emendation and damages.”

According to 4 § in the Law of the National pharmacy register, this register may only contain data about (freely translated) [22]:

“1 day of purchase, article, amount, dosage, and 2 the name and personal identity number of the registered”

As of July 1st 2005, these data are thus registered directly in connection with purchase of prescribed pharmaceuticals The registration is automatic and without the customer’s consent Consent is, on the other hand, required when prescribers or pharmacists need access to these data The national pharmacy register is available for customers at Apoteket’s homepage and to access this, the customers need to log in and identify themselves using a form of electronic identification After that, they can access a list of the prescripted pharmaceuticals they have bought during the last 15 months

Considering the content of the new register, we believe that it must both

be regarded and managed with great sensitivity Therefore, it is important

to have a high level of accountability in the systems and to be able to trace who has requested certain data and why It should also be simple for the customer to check who has made a request like this The problem and importance of achieving the right balance between security and availability

is clearly reflected here In the event of a dispute concerning wrong treatment caused by handing out misinformation and/or the wrong pharmaceutical products, being able to find the accountable party will be very valuable when the evidence is submitted Again, Apoteket’s responsibility will be important since the possibility of accountability partly reflects the work on information security within the organisation

In information security, classification of information is also included, i.e what degree of protection should be assigned to which type of information Considering the increasing service supply at Apoteket, and having in mind the type of information that is processed and transmitted

in the systems on a daily basis (personal data, information about pharmaceutical products, credit report information and so on), an even more important task for Apoteket is to actively pursue the work with classification of information This work also creates the possibility to survey the total amount of information, the degree of protection it has been assigned and how sensitive it is The connection with integrity issues becomes evident; what should be protected and in what way? If this is overlooked and an unwanted situation arises, e.g in the form of personal data leaking out, the confidence and trust that customers have in the trade mark Apoteket could very quickly be damaged Rebuilding what has been lost in a situation like that would take, if at all possible, a very long time and would require the mobilisation of vast resources

Furthermore, one can read the following in the government bill from the Swedish government about the establishment of a national pharmaceutical register (freely translated) [23]:

”A good, secure and cost-effective treatment presupposes that the patient and the prescriber in the treatment situation have access to correct information about different alternatives of treatment, pharmaceutical products, the patient’s recent prescriptions and also other important data concerning the patient.”

Since the government bill declares that prescribers and patients should have access to the correct information, it makes great demands on the party that delivers and supplies this information The party that delivers the information must therefore constantly and actively work with and have control over the security mechanisms that are involved in this process These mechanisms include information security, accountability, network security, physical security and so on This is to, as much as possible, be able to guarantee the quality of the information that is delivered

In the case we are studying, Apoteket is the information delivery party and the types of security related tasks mentioned above are, according to us, not a part of their core business

3.4 Present structure of AKC’s interactive voice response

With the above discussion in mind, the challenges are many and they are all in some way related to issues about information Therefore, one overall challenge will be to assure that information flows and workflows generated within the organisation support the three main tasks mentioned

earlier in Chapter 2 Background:

• Mediates products that are available both with and without prescription and information belonging to them

• Functions as a portal for healthcare

• Promotes better use of pharmaceutical products among Swedish citizens

At present, this is a difficult mission since the workflow more or less is constructed and generated in an ad-hoc manner from the interactive voice response that meets a customer when he or she contacts AKC After studying and outlining the interactive voice response in February 2006 (cf Figure 3.2 and Appendix A), our field studies indicated that it had a non-

dynamic structure in the sense that it is difficult to add new services or options without impairing user-friendliness Furthermore, the present structure is also divided into two levels for reasons that we are not aware

of This situation calls for a more flexible structure, which in turn can act

as a foundation for more flexible models* for the implicit workflows that are connected to the interactive voice response Because we have studied something that exists, i.e the interactive voice response and its present information types, we have also been able to validate our field studies A validation* means that a hypothesis about a phenomenon (real thing) is found to be true Our hypothesis is that the implemented voice response system can be modelled in a purposeful way using information types The validation process consists of two parts:

1 Adequacy The information type model is adequate for modelling relevant (from our perspective) aspects of the existing system

2 Modelling power The information type model is rich enough to allow

us to address some shortcomings of the existing system as well as providing a grounded suggestion that may improve the system (assuring service qualities)

Figure 3.2 outlines the interactive voice response at AKC

Figure 3.2 Tree-structure for the interactive voice response-based workflow

As it is today, a number of options are enumerated to the customer and these options are in turn connected to different services offered by AKC This implies that if AKC wants to extend their number of services then this will affect the number of options enumerated for the customer over the phone; either in the form of a new option in the interactive voice response or in the form of a new telephone number which in turn will have its own interactive voice response This in turn will result in an expansion of the tree-structure, which then will continue to grow; either with a new branch or with a new leaf on an existing branch The interactive voice response will thus become more complex This is something one wants to avoid, since it will in the end have an effect on how many services that can be added to the supply presented in the interactive voice response; too many options are impossible to handle for the customer This may also have a disturbing affect on the organisation’s overall workflow, since we believe that increased complexity will lead to a

Private customers

Level 1

Make reservations with

a health coach or measure your blood pressure

Quit smoking Opening hours

Private customers

Advice concerning anti- smoking

ceuticals for animals

Pharma-Calling from the public medical service

Ideas or complaints Apoteket Plus Automatic opening

hours service

Please hold

greater likelihood of a customer choosing a wrong option and that human agents more often need to redirect events or re-categorize them

3.5 Analysis of error reports

Some examples of real mistakes that can be related to issues of information and which also demonstrate its complexity, can be found in error reports about mistakes made in Apoteket’s context; reports collected from The National Board of Health and Welfare (cf Appendix E) Evident examples of insufficient information quality are found in this report The reported mistakes were made by educated and trained personnel like pharmacists, dispensers, and prescribers The report reveals serious incidents between year 2002 and 2006 from which we have chosen

a few examples (freely translated):

• Misinterpretation of dosage instructions from FASS2

• Incorrect dosage was prescribed on the pharmaceutical label, which led to the dispensing of a higher dose than recommended

• Incorrect dosage in the prescription and also on the pharmaceutical label; 20 dosages three times a day instead of 20 ml three times a day

• Delivery of print-outs of two e-prescriptions at a pharmacy to a patient, of which one of the prescriptions was intended for a person other than the patient Afterwards, both prescriptions were served at another pharmacy in the patient’s name

• Serving of the wrong e-prescription because of inverted numbers

in the patient’s personal identity number

• Serving of e-prescription where the doctor had stated the wrong information about the patient (was logged on to another patient’s medical journal)

• Wrong information in Apoteket’s article register caused by serving

a pharmaceutical with the wrong concentration, which was prescribed as an e-prescription

• Registration error led to purgative (Cilaxoral) being served instead

of prescribed eye drops (Ciloxan)

2 FASS is a reference book with detailed information about pharmaceuticals for sale in Sweden FASS comes in three versions; one for hospital staff, one for the public and one for veterinarians FASS can also be found on the Net [25]

• Mix-up of tetanus vaccine (for veterinary use instead of human use)

• Mix-up of prescriptions Daughter served with Fluoxetin 20 mg x

1 (antidepressant), meant for her mother The eight year old daughter took the pharmaceutical for six days

Some of the examples listed above can be directly connected to the human factor and then principally in connection with misinterpretations; others are a result of the wrong representation in the digital information system In the list above we also find cases that are entirely caused by mix ups of pharmaceuticals as physical products We have not mentioned the latter aspect before, since AKC does not handle physical products in the same ways as the local pharmacies do, where the pharmaceuticals actually are distributed to the customers A possible explanation for these mix-ups can be found in the similarity between boxes and containers of some pharmaceuticals Sometimes there are similar boxes for different pharmaceuticals and sometimes it is difficult to distinguish their concentrations (e.g 5 mg or 1 mg) for the same reason; especially if there are other stress factors involved [24]

Returning to the discussion about information quality in Section 3.3 Legal

framework, we clearly see the consequences of an unsatisfactory

framework In a business concerned with people’s health, there can be serious effects caused by the lack of assured information flows This should not be acceptable within this sector As shown in the examples listed above, it is not merely the lack of information quality that is the cause of these scenarios; with the human factor always present, there will always be human mistakes which we cannot foresee

These real examples demonstrate what can occur when information is wrongly interpreted or misunderstood The examples given above are obtained from local pharmacies, but they could just as well occur at AKC since the overall work procedure is the same (they use the same digital information system, they are governed by the same rules and regulations etc.), with the exception that AKC does not physically handle pharmaceutical products The outcome of mistakes like these shows the importance of constantly pursuing the work of assuring information quality The error reports describe examples of serious error types, and a set of principles is needed to deal with them in the future From the

perspective of our view of information described in Chapter 5 Theoretical

aspects of information and communication, we discuss issues related to these

error types in Chapter 7 Our approach and Chapter 8 Models of validation and

conclusions

To sum up, the actual workflow at AKC is activated when a customer uses the interactive voice response which thus has a great influence on the rest of the workflow This mechanism may at first seem rather insignificant when discussing information quality, but once again we want

to call attention to the fact that the interactive voice response actually initiates and activates AKC’s business processes After studying and mapping the structure of this interactive voice response, we found that it

is very inflexible and presents too many options to choose from and that this is true for private customers as well as for professional customers (these two categories have separate telephone numbers when contacting AKC) This structure makes it difficult to expand the service supply without affecting the overall number of choices towards the customers What we want to achieve, is an underlying structure that is dynamic and flexible with the possibility to easily add or remove services We believe that this is important, since we have noticed that the structure in the interactive voice response is also mirrored in the structure of the underlying event handling system Considering that AKC will probably offer a number of new services in the near future, there is a risk that the tree-structure in the interactive voice response will grow accordingly The same will happen with the event handling system, i.e the number of event categories will increase and the system will be more complex and difficult

to work with If the interactive voice response system presents too many options to the customer to choose from, the chance that the customer selects the wrong alternative will increase This may lead to a human agent re-categorising the incoming event, and this will, in turn, slow down the overall workflow or channel the event to a human agent with the wrong competence and so on This also has to do with common ground; if the right alternative is chosen in the interactive voice response from the beginning, the interactive voice response can give the right input to the dialogue and facilitate the building of a common ground

3.6 Towards a configurable methodology

The challenges mentioned above include people, information and technology in some way, i.e they concern socio-economic-technical systems Thus, Figure 1.1 will once again be useful in explaining what we mean with quality assurance of information flows and workflows at AKC The figure also points out that an overall picture is needed to observe relevant scientific methodology* areas and that one single method or one single approach is not enough The figure describes when suitable

methods and approaches are relevant and that all of them may not always

be used together; they are used when they are needed By this, we can also achieve a more sustainable methodology

3.6.1 Own contributions towards an assured workflow at AKC

As shown in the picture, workflows constitute a part of a technical system These workflows are in turn built upon a number of interconnected tasks which are performed either by humans (in this case called human agents) or machines When one task is executed, a transition

socio-economic-to the next task occurs and in most cases the result from one task is used

as input to the next task in the workflow The dotted circles in Figure 3.3 mark these transitions and according to us they constitute critical sequences in a workflow This has to do with the handover situation that takes place between the tasks i.e the state where a task transitions into another task When this occurs, information is most likely also transported which in that case indicates that an information flow exists What we want

to do is to assure the quality of this information flow since it usually constitutes input to the next step Incorrect input of one task will affect the whole workflow and in the end also the entire supply of services – digital as well as non-digital This serves as an example of poor information quality The handover situations are thus critical, especially if

a new human agent takes over a certain task or the workflow as a whole The overall challenges that thus arise are: in what way can we analyse a workflow of this kind at AKC so as to prevent the perilous situation in the handover situations from arising, how do we create a workflow that can be reused and finally how can we understand what really happens in these situations at a deeper level?

Figure 3.3 Different aspects and issues concerning socio-economic-technical systems

Other challenges of interest are related to in- and outsourcing* These challenges will gradually appear in the upper part of Figure 3.3 if the context described in the figure is viewed as an information ecology In AKC’s information ecology, customers, human agents, information resources and tools collaborate in carrying out incoming events However, here one must say that the role of the human agents who work as pharmacists, is somewhat more central than the other agents’ roles, since they are the ones who possess the relevant competence and knowledge of the pharmaceutical issues essential for AKC’s business Thus, the human agents with their specific competences can be seen as invariants in the information ecology

If one now wants to pursue in- or outsourcing, the crucial question is: how should this be approached? Which criterion should first be

Customer

Pharmacist’s information ecology Non-pharmacist’s

information ecology

Support-system requirements

High-level requirements Support

Ethnographical aspects

Infosense aspects

Service Oriented Architecture Information Ecologies

Service Level Agreement

Service bundle

Workplace

considered and maybe also guide the whole process; is it the economy, the core business, the knowledge assets or does it all depend on the overall rate of efficiency? For most organisations, the first mentioned criterion is probably the answer, i.e the economy Many organisations outsource parts of their business with the purpose of saving money in order to become more efficient and thus be able to focus on their core business A very important issue here is to be able to actually define the core business

To many organisations, this may seem like a simple task It is commonly assumed that the core business consists of the things the company does every day If we take AKC as an example, this would probably mean mediating pharmaceutical information to customers But there are other things that can also be regarded as part of the core business, for instance questions asked by the customer with reference to their

“högkostnadsskydd”3, or the possibility to pay in instalments (which requires a customer credit rating) and so on The credit rating, for example, is not AKC’s area of expertise since the human agents are focused on, trained and educated in pharmaceutical issues Even so, AKC provides this service to the customer Other services that have been added

to AKC’s line of services, and which could be said to have an indirect connection to the core business, are for instance, overall health care issues such as how to quit smoking or the possibility to make reservations with a health coach (which includes measuring ones blood pressure, weight and waist etc.) Another service recently added to AKC is counselling concerning organ donation and this function was taken over from the National Swedish Board of Health and Welfare

The described cases are just some examples of the events that AKC handles daily (a more detailed description of AKC’s service supply is

found in Chapter 4 Services and service development) These cases furthermore

prompt the question: what really constitutes AKC’s core business? At a first glance it is still the pharmaceutical information mediating process, but it is equally obvious that a number of other services are closely related

to this process This is what makes it difficult to define AKC’s core business in a simple way, without further discussion Moreover, the concept of a core business is often associated with outsourcing issues, but the fact is that it is just as important for insourcing* issues, i.e the types

of services the organisations add to the existing range (the case with AKC providing the customer with a credit rating is a good example of this)

3 In Sweden, the amount of money a patient needs to pay for healthcare and prescribed pharmaceuticals is limited by a cost ceiling